Organisation Name (required)

Organisation Type (e.g. Pharmaceutical Industry, Academic, Hospital) (required)

Organization business area /specialisation ( eg. Pharma R&D, Devices) (required)

Applicant's Name (required)

Applicant's Address (required)

Phone Number (required)

Your Email (required)

Background of the applicant (brief CV relevant to EuPFI activities) (required)

Level of membership/sponsorship (required)

Amount of funding offered (required)

Resources /expertise available to contribute (required)

Please list the workstreams you want to be involved (may select more than one workstream) (required)

Please suggest the contribution you could offer to the workstream (required)

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How did you learn about membership opportunity? (required)

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